A comparison of surgical outcomes between outpatient and inpatient robot-assisted radical prostatectomy: A systematic review and meta-analysis

IF 2.7 2区医学 Q2 UROLOGY & NEPHROLOGY

Prostate International Pub Date : 2025-03-01 DOI:10.1016/j.prnil.2024.04.003

Tuan T. Nguyen , Muhammed A. Moukhtar Hammad , Ryan W. Dobbs , Huy G. Vuong , Jacob Basilius , Khoa Quy , Hanh T.T. Ngo , An Nguyen , Thi Tuyet Mai Tran , Narmina Khanmammadova , Trinh N.K. Van , Sohrab N. Ali , Ho Yee Tiong , Se Young Choi , Mohammed Shahait , David I. Lee

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引用次数: 0

Abstract

Introduction

Several institutions have reported their experience with outpatient robot-assisted radical prostatectomy (O-RARP). However, it is unclear if the utilization of this approach represents an improvement over inpatient robot-assisted radical prostatectomy (I-RARP). This meta-analysis sought to compare the surgical outcomes between O-RARP and I-RARP.

Methods

For relevant articles, three electronic databases, including PubMed, Scopus, and Web of Science, were searched from their inception until April 30, 2022. A meta-analysis has been reported in line with PRISMA 2020 and AMSTAR guidelines. The risk ratio (RR) and weighted mean difference (MD) were applied for the comparison of dichotomous and continuous variables with 95% confidence intervals (CI).

Results

of the 297 retrieved abstracts, 12 underwent full-text review, and 11 studies were included in the final analysis, comprising a total cohort of 2,875 cases of robot-assisted radical prostatectomy (892 O-RARP cases and 1,983 I-RARP cases). Compared to I-RARP, the O-RARP group had lower mean operative time (MD = −9.4 minutes, 95% CI −15.1 to −3.7, P = 0.001), fewer overall postoperative complications (RR = 0.65, 95% CI 0.46 to 0.92, P = 0.017), shorter hospital stay (MD = −22.9 hours, 95% CI −26.0 to −19.7, P ≤ 0.001), and lower postoperative opioid requirements (RR = 0.45, 95% CI 0.28 to 0.71, P = 0.001). There were no significant differences in other outcomes, including: estimated blood loss, postoperative pain score, unscheduled visits after surgery, positive surgical margins, biochemical recurrence, International Prostate Symptom Score (IPSS) after surgery, or three- and six-month continence rates.

Conclusions

This meta-analysis demonstrates that O-RARP is a safe and feasible option for patients undergoing surgery for localized prostate cancer. Further studies are needed to better evaluate optimal patient selection, associated healthcare costs, and patient-reported outcomes.

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门诊与住院机器人辅助根治性前列腺切除术的手术效果比较：系统回顾与元分析

几家机构报道了他们门诊机器人辅助根治性前列腺切除术（O-RARP）的经验。然而，目前尚不清楚这种方法的使用是否比住院机器人辅助根治性前列腺切除术（I-RARP）有改善。本荟萃分析旨在比较O-RARP和I-RARP的手术结果。方法检索PubMed、Scopus和Web of Science三个电子数据库，从其成立到2022年4月30日，检索相关文章。根据PRISMA 2020和AMSTAR指南报道了一项荟萃分析。采用风险比（RR）和加权平均差（MD）对二分变量和连续变量进行95%置信区间（CI）的比较。在297篇检索到的摘要中，12篇进行了全文综述，11项研究被纳入最终分析，包括2875例机器人辅助根治性前列腺切除术（892例O-RARP病例和1983例I-RARP病例）。与I-RARP相比，O-RARP组平均手术时间更短（MD = - 9.4分钟，95% CI为- 15.1至- 3.7,P = 0.001），术后总并发症更少（RR = 0.65, 95% CI为0.46至0.92,P = 0.017），住院时间更短（MD = - 22.9小时，95% CI为- 26.0至- 19.7,P≤0.001），术后阿片类药物需求更低（RR = 0.45, 95% CI为0.28至0.71,P = 0.001）。其他结果没有显著差异，包括：估计失血量、术后疼痛评分、术后未安排的就诊、手术边缘阳性、生化复发、术后国际前列腺症状评分（IPSS）或3个月和6个月的失禁率。结论：本荟萃分析表明，O-RARP对于局部前列腺癌手术患者是一种安全可行的选择。需要进一步的研究来更好地评估最佳患者选择、相关的医疗保健成本和患者报告的结果。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Prostate International Medicine-Urology

CiteScore

4.40

自引率

26.70%

发文量

审稿时长

35 days

期刊介绍： Prostate International (Prostate Int, PI), the official English-language journal of Asian Pacific Prostate Society (APPS), is an international peer-reviewed academic journal dedicated to basic and clinical studies on prostate cancer, benign prostatic hyperplasia, prostatitis, and ...